FREE Sports Physicals – 3/16/16

Posted on February 26, 2016.

Winter sports are winding down, but spring is just around the corner.  Parents and athletes … Read More

Christmas Eve Office Hours – Closing at 3PM

Posted on December 18, 2015.

PLEASE BE ADVISED: Our offices will be closing at 3pm on Thursday December 24th.

Youth Sports Safety Week 2015

Posted on November 4, 2015.

Youth Sports Safety Week Youth Sports Safety Week offers something for everyone! There are opportunities … Read More

New Hampshire Orthopaedic Center

How to Lose Weight When Your Joints Hurt

Posted on April 26, 2016.

by: Kathleen A. Hogan, MD

People who are obese (body mass index -BMI >30) have an almost seven times increase in the incidence of knee arthritis compared to those with a normal body mass index (BMI 18.5-25). Weight loss has been shown to reduce the pain associated with knee arthritis and improve function.  However, many of my patients with severe knee or hip arthritis tell me that they are unable to lose weight because they cannot exercise due to their arthritis pain. How can you lose weight when you cannot exercise?  

This article is meant to give you some suggestions and ideas on how to lose weight when your joints hurt too much to exercise. You should talk with your medical doctor before starting a weight loss program, and about specific dietary or physical limitations you may have.

Keep a Food Diary

My first suggestion is to keep a food diary. There are many free apps that you can download to your phone or computer which determine the caloric content of what you eat. For some people, just keeping track of calories can prevent over eating. Some patients tell me they do not eat very much but still gain weight.

Sometimes it is not how much you are eating but what you are eating.  For example, 200 calories can be a plate overflowing with broccoli or carrots, half a hamburger, or half a candy bar.  Which is going to fill you up the most? Unfortunately the candy bar tastes the best!  Keep in mind that 200 extra calories take approximately an hour of walking to burn off!

Use Calorie Information to Make Healthier Choices

Many restaurants now list calories which can help you make healthier choices. The cafeteria at Catholic Medical Center lists “better alternatives” to high calorie foods. For example, who would have guessed that Baked Potato chips have less calories and fat (130 cal, 2g fat) then French Fries (300 cal, 15 g fat)? A bagel with cream cheese has over 400 calories compared to only 170 calories in a slice of french toast. Small changes in food choices can sometimes make a large difference in the number of calories consumed throughout the day.

Be Active Throughout the Day

Being active throughout the day is also important. This increases the number of calories you burn.  If you are very sedentary, you will need to consume considerably less calories each day to avoid gaining weight compared to someone who is more active.

Many patients with arthritis complain that their joints feel stiff when they get up from sitting.  Your joints are made to move. Movement lubricates all joints, even those with arthritis. Just because your knees hurt too much to run on the treadmill does not mean that you cannot exercise.

Do Low Impact Exercise

Swimming, water aerobics, biking, and the elliptical trainer all put less impact on your joints then walking. Strength training builds muscle and burns calories. It also builds bone density. The stronger your muscles are, the better they support your joints which reduces pain from arthritis. If you have never lifted weights before, you may want to start off by working with a sports trainer or physical therapist to learn how to do it correctly.

Barre, pilates, and yoga classes can also improve your flexibility, strength, and balance in addition to burning calories.  Some gyms and senior centers offer classes specifically designed for people who have arthritis.    Exercising with other people can help you stay motivated.  Even thirty minutes a day of exercise can have a positive effect.

Don’t Give Up

Do not give up. Just because you had a cupcake and sat on the couch tonight watching television does not mean you cannot exercise or lose weight. Try not to be too hard on yourself and set realistic goals so that you will achieve them.  Arthritis may make weight loss more challenging, but nothing is impossible. The first step is always the most difficult.

Do I Need a Joint Replacement?

Posted on March 24, 2016.

by: Kathleen A. Hogan, MD

As a specialist in joint replacement, I am frequently asked “How will I know when it is time to have my hip or knee replaced?”  As we age, most people experience intermittent pain in their joints, usually worse with activity.   Sometimes this pain is due to arthritis, but there are many other causes of joint pain. A few of these causes  include muscle pain, stress fractures, tendonitis, fibromyalgia, Lyme disease, and inflammatory conditions. Arthritis is caused by damage to the cartilage of a joint.   Pain from arthritis is  the result of the inflammation this cartilage damage generates.   Arthritic pain is often intermittent.  If you have arthritis it is likely that you will have good and bad days.  You may feel worse with changes in the weather.   X-rays may show loss of cartilage and development of bony deformities.   

Not all patients with hip and knee arthritis will need joint replacement surgery.  Some patients have x-rays which show they have terrible arthritis and yet they continue to be active.   Symptoms of pain and swelling can often be treated with anti-inflammatory medications and corticosteroid injections.   Improving muscle strength can help reduce stress on the joint.   Canes and walkers can be used to decrease the force of body weight on the joint.  Weight loss can be especially beneficial as you place forces of up to 5 times your body weight across your knee joint during stair climbing.

Most of my patients with arthritis want me to tell them if they are ready for a joint replacement.  My response is that you will tell me when you are ready for surgery.  Only you know if the discomfort and pain that you experience is bad enough to have a major surgery.   Does your knee or hip hurt you every day? Does your arthritis pain keep you from doing things that you enjoy? Keep in mind that joint replacement does not give you back the knee or hip you had when you were 20 years old.  This is an artificial joint made of metal and plastic.  It will feel better than your arthritic joint but different than a normal one! The majority of people who have their hip or knee replaced are happy with the results and feel that they “have been given their life back”.  

Joint replacement surgery is not without risks.  Although complications are rare, they can and do occur.   When your arthritis pain can no longer be improved with other treatments, the benefits of surgery – relief of pain, improvement in mobility, increased function – far outweigh the risks.  No one should feel they were “talked into” having joint replacement surgery by their surgeon or even by a family member.   Deciding to go forward with joint replacement surgery is a decision which will have a major impact on the rest of your life, and it needs to be your decision.  

Four of Our Physicians Named ‘Top Docs’ for 2016

Posted on March 20, 2016.

Each year, roughly 3,000 physicians licensed to practice in New Hampshire are asked by New Hampshire Magazine to nominate specialists they would most recommend to family and friends. Those selected as ‘Top Doctors’ received the greatest number of recommendations within 45 specialties. New Hampshire Orthopaedic Center physicians have been voted ‘Top Doctors’ in New Hampshire Magazine 30 times since 2001-more than any other orthopaedic group in the state.
The votes for 2016 have been counted and four New Hampshire
Orthopaedic Center physicians have been included in the Top Doctor listing:
Eric Benson, MD –  Leading Physician for Orthopaedic Surgery
Daniel Bouvier, MD – Leading Physician for Orthopaedic Surgery & Sports Medicine
Robert Heaps, MD –  Leading Physician for Hand Surgery
Jinsong Wang, MD –  Top Vote Getter for Hand Surgery
Congratulations to all those voted  ‘Top Doctors’ for 2016.

Viscosupplementation for Knee Arthritis

Posted on March 4, 2016.

by: Kathleen A Hogan, MD

Over 30% of Americans over the age of 60 are affected by the symptoms of knee arthritis, such as pain, stiffness, swelling, and activity limitations.  Initial treatments for knee arthritis include activity modification, weight loss, physical therapy, bracing, anti-inflammatory medications, and injections with steroids or hyaluronic acid (also called a gel or visco because of its consistency).   

Corticosteroid Injections

Corticosteroid injections have been used since the 1950’s to treat painful, inflamed, arthritic joints.   However, they can cause temporary elevation of blood sugar in diabetics and may only give 3 months of pain relief.  Even if effective in the past, repeated steroid injections may no longer provide relief.  There is concern that too many steroid injections may damage normal cartilage, especially in patients with less severe arthritis.  Steroid injections which are given within 3 months of a joint replacement surgery may even increase the risk of infection slightly.

Hyaluronic Acid Injections (or Viscosupplementation)

Hyaluronan is a complex molecule found in normal joint fluid which acts as a lubricant and a shock absorber.  Injections of a joint with hyaluronic acid may improve the protective effects of normal joint fluid and also reduce inflammation. First approved by the FDA in 1997, there are now several different types of hyaluronic acid injections available, including Synvisc, Euflexxa, Orthovisc, and Gel One.  This type of injection is also known as viscosupplementation.   Most require an average of 3 injections, one week apart, although some can be given as a single injection.

What to Expect

If your physician recommends viscosupplementation for knee arthritis, it usually must be approved by your insurance carrier before it can be given.  You will return to the office for the injections.  The skin will be cleaned with an antiseptic such as betadine, and the skin numbed with lidocaine or a cold spray.  Some physicians use ultrasound to ensure the injection is accurately placed within the joint.  Excessive fluid in the knee may be aspirated and removed at the same time as the injection, which can also provide substantial pain relief.

After the Injection

After the injection, it is typically recommended that patients avoid excessive activity for 2 to 3 days.  This helps to minimizes discomfort associated with the injection.  Bleeding within the joint after an injection can occur in patients on aspirin, Coumadin, or other anticoagulants.  It typically takes a few weeks after completing the injections to obtain maximum relief of symptoms.  Pain relief should last 6 to 12 months.  These injections can be repeated every 6 months.

Effectiveness of Viscosupplementation for Knee Arthritis

Viscosupplementation does not always give complete relief of pain.  Studies have provided conflicting evidence on its effectiveness.   A torn meniscus may be aggravating the knee joint and causing continued pain.  Once arthritis becomes severe, these injections may no longer be effective. Or pain which is felt in the knee may actually be caused by arthritis elsewhere, such as the hip or spine.   Not everyone is a candidate for viscosupplementation but for some patients they can provide significant relief of the pain from knee arthritis.  If you are one of the million of Americans suffering from knee arthritis, there are often many treatments which can help to reduce knee pain and may help some people avoid or put off joint replacement surgery.

Cross Training and Whole Body Fitness

Posted on March 3, 2016.

By: Daniel Bouvier, MD In this current age athletes participate in sports well into middle age and beyond. We find children specializing in sports at a young age, high volume, and high intensity early in their skeletal development. Gone are the days of free play, climbing trees, building walls and forts, and kickball games in a neighbor’s back yard. Early specialization and repetition, as well as participation later in our years, can be a recipe for injury.

What Can We Do to Optimize our Body’s Strength and Conditioning?

Cross training and whole body fitness can go a long way toward making our bodies more durable, more balanced, and less at risk for injury both at work and at play. Strength and conditioning allows us to participate in the sports and activities we love without the increased risk of injury.

Types of Cross Training:

Cross training may be as simple as doing something different from the specific activities of a single sport that one may be performing over and over again in a week. One example would be cycling or swimming, as opposed to running every day. Modern day whole body fitness incorporates total body fitness with some sport specific focus designed to make the athlete better prepared to perform their sport and to hopefully lessen the risk of injury.

Benefits of Strength and Agility Training:

  • Increased strength of muscles can lead to increase performance due to higher and more efficient energy output, which may increase speed and explosiveness.
  • Combine flexibility and proper movement patterns, which can lessen the incidence of injury.
  • Increased balance, agility, and coordination.
  • Dynamic stabilization of joints that may otherwise be at increased risk for injury.
  • Can decrease the rate of normal muscle loss that occurs after age 30.
  • Can maintain bone density and prevent or slow osteoporosis, and increase the basal metabolic rate (burn more calories at rest).

Benefits of Cross Training:

  • Cross training is used often if an athlete is unfortunate enough to sustain an injury, whether it needs surgery or simply rest. “Rest” does not mean inactivity, but sometimes can mean “different” activity. Using things like stationary cycles and swimming pools, athletes can maintain a level of fitness while allowing injuries to heal on other parts of the body.
  • Cross training can also be used to create more complete balance amongst multiple muscle groups to attain a more “diverse” level of fitness, as opposed to training the same muscles over and over again to perform the same task. This is likely to decrease our risk of injury and create a more “durable” athlete.

Getting Involved:

When deciding to begin a strength and conditioning program, there are a few recommendations to consider:

    • Begin with a certified, educated person who can observe your movement and techniques to assure that you are doing things correctly. You may want to ask if they are certified in the FMS®, or functional movement screen, a tool designed to assess movement abnormalities and areas of weakness so that areas of focus and balance can be created for you.
    • Avoid training without adequate supervision, or in groups that become large enough that you’re not getting the attention you need. Improper technique is easy to fall into, especially when fatigue or a time clock is upon you.
    • Expanding on the previous point, be very cautious about using programs designed PRIMARILY around maximum repetitions for speed and weight, especially if there is not a trainer or partner with you during these.

Modern day strength and conditioning, as well as cross training, are tools that we as health care providers as well as you as athletes and weekend warriors can use wisely to improve health, protect and prevent injuries, and safely return everyone back to the activities they enjoy.